Three Case Definitions of Malaria and Their Effect on Diagnosis, Treatment and Surveillance in Cox's Bazar District, Bangladesh

By Montanari, R. M.; Bangali, A. M. et al. | Bulletin of the World Health Organization, July 2001 | Go to article overview

Three Case Definitions of Malaria and Their Effect on Diagnosis, Treatment and Surveillance in Cox's Bazar District, Bangladesh


Montanari, R. M., Bangali, A. M., Talukder, K. R., Baqui, A., Maheswary, N. P., Gosh, A., Rahman, M., Mahmood, A. H., Bulletin of the World Health Organization


Voir page 655 le resume en francais. En la pagina 655 figura un resumen en espanol.

Introduction

Since the inception of the global Malaria Eradication Programme in 1961, malaria blood slide results and related indicators have been at the centre of the malaria eradication strategy worldwide, and have been used to analyse the malaria situation in Bangladesh (Table 1). The justification for this approach came from the definition of epidemiological surveillance used in malaria eradication programmes as a series of epidemiological (and remedial) measures to achieve eradication. Epidemiological surveillance consisted of "the detection of cases through a screening mechanism of the whole population; the screening criterion is the presence of fever, which leads to the microscopic examination of the blood of every subject having fever or having recently had fever" (1). Cases with parasites in the blood were submitted to radical treatment. This was considered one remedial measure; the other was the administration of a single dose of chloroquine to all fever cases when taking blood samples. In 1969, the global malaria strategy changed from eradication to control, yet the surveillance practices of the malaria eradication era continue to be used in Bangladesh. Bangladesh is not unique in this respect. Following the Amsterdam Ministerial Conference in 1992 a change from specialized information systems to integrated ones was seen as essential, together with "a radical redefinition of the information that should be collected" (2). In many instances, however, general health services continue to follow traditional eradication screening criteria, long after the eradication strategy has been abandoned (3).

Table 1. Laboratory-confirmed cases of malaria in Bangladesh,
1963-97(a)

Year     Country     Number of   ABER(b)    No. of    API(c)   SPR(d)
       population     blood        (%)     malaria              (%)
                      slides               positive
                     examined               slides

1963     1 895 000      86 345    4.56         402     0.21     0.47
1964     8 962 000     474 569    5.30         756     0.08     0.16
1965    12 035 000     975 918    8.11         649     0.05     0.07
1966    21 203 000   1 715 771    8.09       3 137     0.16     0.20
1967    26 874 000   2 485 901    9.25       4 080     0.15     0.16
1968    47 002 000   2 988 322    6.36       6 244     0.13     0.21
1969    59 444 000   4 880 511    8.21       7 871     0.13     0.16
1970    62 810 000   6 107 144    9.72       6 660     0.11     0.11
1971    63 570 000   2 212 660    3.48       2 944     0.05     0.13
1972    65 220 000   5 311 988    8.14      18 384     0.28     0.35
1973    69 288 000   3 259 190    4.70      14 007     0.20     0.43
1974    71 565 000   1 884 109    2.63      15 855     0.22     0.84
1975    72 730 000   2 929 935    4.03      31 247     0.43     1.07
1976    73 930 000   3 537 269    4.78      48 844     0.66     1.38
1977    76 395 000   1 414 731    1.85      29 673     0.39     2.10
1978    78 916 000   1 391 055    1.76      33 326     0.42     2.40
1979    81 520 000   1 374 104    1.69      49 776     0.61     3.62
1980    84 210 000   2 634 773    3.13      67 717     0.80     2.57
1981    88 100 000   2 338 853    2.65      45 902     0.52     1.96
1982    90 300 000   2 808 765    3.11      46 781     0.52     1.67
1983    92 200 000   2 516 110    2.73      42 529     0.46     1.69
1984    94 300 000   2 552 513    2.71      32 977     0.35     1.29
1985    96 400 000   2 823 028    2.93      31 050     0.32     1.10
1986    98 000 000   2 685 529    2.74      93 128     0.40     1.46
1987    99 800 000   2 771 577    2.78      35 848     0.36     1.29
1988   101 500 000   2 704 563    2.66      33 824     0.33     1.25
1989   103 800 000   3 152 310    3.04      50 738     0.49     1.61
1990   106 100 000   2 444 415    2.30      53 875     0. … 

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